picc insertion into small veins

Need help with technique on placing piccs into small veins. Can access them with ultra sound and the wire, but the introducer appears to thread but no blood return and then unable to access vein. I believe the introducer is damaging the vein. I use a 4 fr kit with a 4.5 introducer's would it be better to use the 3 fr piccs or is it just some veins not accessible. Any techniques to get these small veins especially on obese patients and very dehydrated patients.

You might consider looking harder for a better vein. Trying to put a catheter of any sort (PIV,Midline or PICC) into a vein that is too small is asking for trouble down the road--you increase the risk of phlebitis and thrombosis too much to outweigh the benefit of having the line.

Jan 7, '07

One thing I forgot to add was to consider doing the initial assessment of the arm and veins WITHOUT the tourniquet. That way you know what the vein's true diameter is and whether it will safely accept the catheter size the patient needs.